Healthcare Provider Details

I. General information

NPI: 1609854066
Provider Name (Legal Business Name): AMAL GUBARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax: 202-483-8196
Mailing address:
  • Phone: 202-483-8196
  • Fax: 202-483-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD041328
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: